Provider Demographics
NPI:1780687087
Name:MANSFIELD, SHAYNA M (DO)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:M
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4545 E SHEA BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3061
Mailing Address - Country:US
Mailing Address - Phone:480-292-9532
Mailing Address - Fax:602-324-0239
Practice Address - Street 1:4545 E SHEA BLVD STE 130
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3061
Practice Address - Country:US
Practice Address - Phone:480-292-9532
Practice Address - Fax:480-664-3482
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI15556Medicare UPIN
AZ83640Medicare ID - Type Unspecified